Nursing Bullets: Psychiatric Nursing I

According to Kübler-Ross, the five stages of death and dying are denial, anger, bargaining, depression, and acceptance.

Flight of ideas is an alteration in thought processes that’s characterized by skipping from one topic to another, unrelated topic.

La belle indifférence is the lack of concern for a profound disability, such as blindness or paralysis that may occur in a patient who has a conversion disorder.

Moderate anxiety decreases a person’s ability to perceive and concentrate. The person is selectively inattentive (focuses on immediate concerns), and the perceptual field narrows.

A patient who has a phobic disorder uses self-protective avoidance as an ego defense mechanism.

In a patient who has anorexia nervosa, the highest treatment priority is correction of nutritional and electrolyte imbalances.

A patient who is taking lithium must undergo regular (usually once a month) monitoring of the blood lithium level because the margin between therapeutic and toxic levels is narrow. A normal laboratory value is 0.5 to 1.5 mEq/L.

Early signs and symptoms of alcohol withdrawal include anxiety, anorexia, tremors, and insomnia. They may begin up to 8 hours after the last alcohol intake.

Al-Anon is a support group for families of alcoholics.

The nurse shouldn’t administer chlorpromazine (Thorazine) to a patient who has ingested alcohol because it may cause oversedation and respiratory depression.

An alcoholic who achieves sobriety is called a recovering alcoholic because no cure for alcoholism exists.

According to Erikson, the school-age child (ages 6 to 12) is in the industry-versus-inferiority stage of psychosocial development.

When caring for a depressed patient, the nurse’s first priority is safety because of the increased risk of suicide.

Echolalia is parrotlike repetition of another person’s words or phrases.

According to psychoanalytic theory, the ego is the part of the psyche that controls internal demands and interacts with the outside world at the conscious, preconscious, and unconscious levels.

According to psychoanalytic theory, the superego is the part of the psyche that’s composed of morals, values, and ethics. It continually evaluates thoughts and actions, rewarding the good and punishing the bad. (Think of the superego as the “supercop” of the unconscious.)

According to psychoanalytic theory, the id is the part of the psyche that contains instinctual drives. (Remember i for instinctual and d for drive.)

Denial is the defense mechanism used by a patient who denies the reality of an event.

In a psychiatric setting, seclusion is used to reduce overwhelming environmental stimulation, protect the patient from self-injury or injury to others, and prevent damage to hospital property. It’s used for patients who don’t respond to less restrictive interventions. Seclusion controls external behavior until the patient can assume self-control and helps the patient to regain self-control.

A patient who takes a monoamine oxidase inhibitor should be weighed biweekly and monitored for suicidal tendencies.

If the patient who takes a monoamine oxidase inhibitor has palpitations, headaches, or severe orthostatic hypotension, the nurse should withhold the drug and notify the physician.

Common causes of child abuse are poor impulse control by the parents and the lack of knowledge of growth and development.

The diagnosis of Alzheimer’s disease is based on clinical findings of two or more cognitive deficits, progressive worsening of memory, and the results of a neuropsychological test.

Memory disturbance is a classic sign of Alzheimer’s disease.

Thought blocking is loss of the train of thought because of a defect in mental processing.

A compulsion is an irresistible urge to perform an irrational act, such as walking in a clockwise circle before leaving a room or washing the hands repeatedly.

A patient who has a chosen method and a plan to commit suicide in the next 48 to 72 hours is at high risk for suicide.

The therapeutic serum level for lithium is 0.5 to 1.5 mEq/L.

Phobic disorders are treated with desensitization therapy, which gradually exposes a patient to an anxiety-producing stimulus.

Dysfunctional grieving is absent or prolonged grief.

During phase I of the nurse-patient relationship (beginning, or orientation, phase), the nurse obtains an initial history and the nurse and the patient agree to a contract.

During phase II of the nurse-patient relationship (middle, or working, phase), the patient discusses his problems, behavioral changes occur, and self-defeating behavior is resolved or reduced.

During phase III of the nurse-patient relationship (termination, or resolution, phase), the nurse terminates the therapeutic relationship and gives the patient positive feedback on his accomplishments.

According to Freud, a person between ages 12 and 20 is in the genital stage, during which he learns independence, has an increased interest in members of the opposite sex, and establishes an identity.

According to Erikson, the identity-versus-role confusion stage occurs between ages 12 and 20.

Tolerance is the need for increasing amounts of a substance to achieve an effect that formerly was achieved with lesser amounts.

Suicide is the third leading cause of death among white teenagers.

Most teenagers who kill themselves made a previous suicide attempt and left telltale signs of their plans.

In Erikson’s stage of generativity versus despair, generativity (investment of the self in the interest of the larger community) is expressed through procreation, work, community service, and creative endeavors.

Alcoholics Anonymous recommends a 12-step program to achieve sobriety.